Aspirin and nonsteroidal anti‐inflammatory drug use and keratinocyte cancers: a large population‐based cohort study of skin cancer in Australia

Abstract

Summary Background Nonsteroidal anti‐inflammatory drugs (NSAIDs) have been postulated as chemopreventive agents for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), but findings from observational studies have been inconsistent, and clinical trial data are scant. Objectives To examine the association between aspirin and NSAID (nonaspirin) use and the risk of BCC and SCC in a large cohort specifically designed for skin cancer outcomes. Methods We used data from the QSkin Study, a prospective cohort of 43 764 residents of Queensland, Australia (34 630 were included in this study and 23 581 were used in our primary analyses). We used Cox proportional hazards models to estimate the hazard ratios (HRs) between self‐reported aspirin and NSAID use 1 year prior to study baseline and the first histologically confirmed BCC or SCC for high‐risk (history of skin cancer excisions or more than five actinic lesions treated) and average‐to‐low‐risk participants (no history of skin cancer excision and at most five actinic lesions treated). Results After a median of 3 years of follow‐up, 3421 participants developed BCC and 1470 SCC (2288 BCC and 932 SCC with complete covariate information). Among the high‐risk group (1826 BCC and 796 SCC), compared with never use, frequent (at least weekly) NSAID use was associated with reduced risk of BCC (HR 0·84, 95% confidence interval 0·71–0.99) but not SCC. Aspirin use was associated with reduced risk of SCC (HR 0·77, 95% confidence interval 0·64–0·93) only among infrequent (less than weekly) users and was not associated with BCC. We observed no association between NSAID or aspirin use and the risk of BCC or SCC among average‐to‐low‐risk participants. Conclusions While some weakly inverse associations were observed between prior use of aspirin or NSAIDs and skin cancer, the inconsistent patterns of associations do not provide convincing evidence that these medications reduce subsequent skin cancer risk. Further data on doses, duration and long‐term follow‐up may help us to comprehend the cumulative dose effect.

Nonsteroidal anti‐inflammatory drug associations with nonmelanoma skin cancer – the saga continues

“…In this issue of BJD , Pandeya et al . conducted a large prospective cohort study that appraised the role of chemopreventive agents, NSAIDs including aspirin and their role in the development of SCC and BCC . Utilizing data from the QSkin Study with over 43 000 individuals, Pandeya et al .…”

“…Pandeya et al . 's work is a significant contribution to elucidating the relationship between NSAIDs and NMSC . Moving forward, new RCTs concerning specific NSAIDs and a greater understanding of the anticarcinogenic effects of these therapeutics will further explain these chemopreventive agents.…”

“…[8][9][10] In this issue of BJD, Pandeya et al conducted a large prospective cohort study that appraised the role of chemopreventive agents, NSAIDs including aspirin and their role in the development of SCC and BCC. 11 Utilizing data from the QSkin Study with over 43 000 individuals, Pandeya et al collected selfreported NSAID use and juxtaposed it to histopathologically confirmed BCCs and SCCs. The authors stratified their patient populations into low, medium (no excised skin cancers and ≤ 5 treated actinic lesions) and high risk (≥ 1 excised skin cancers or >5 treated actinic lesions) based on patient history.…”

“…Pandeya et al demonstrated weak and inconsistent patterns with NSAID and aspirin use in the prevention of NMSC. 11 There may be a role for future RCTs that appraise specific NSAIDs and their respective dosage. Additional studies are likely necessary to determine the appropriate NSAID for future RCTs.…”

Obituary: Professor Marcel F. Jonkman: 1957–2019

“…DEAR EDITOR, Thank you for the opportunity to respond to the letter from Abtahi and colleagues 1 on our recent paper describing the association between aspirin and nonsteroidal anti-inflammatory drug (NSAID) use and keratinocyte cancer (KC). 2 It allows us to clarify several important points. Firstly, we reiterate that we assessed the cross-sectional exposure prevalence of aspirin and NSAID use at study baseline (within 1 year prior) and our results should be interpreted in that context.…”